A prospective case series of sphenopalatine ganglion pulsed radiofrequency therapy for refractory chronic cluster headache

Abstract

Background and purpose: The management options for chronic cluster headache (CCH) are limited and a significant proportion of patients become refractory to pharmacological treatments. Pulsed radiofrequency (PRF) of the sphenopalatine ganglion (SPG) may present an efficacious, minimally invasive treatment modality for patients with refractory CCH. We describe the clinical outcomes of 14 patients with refractory CCH treated with PRF of the SPG. Methods: Patients with medically refractory CCH who underwent percutaneous SPG-PRF treatment between January 2016 and April 2019 were included in this report. Patients obtaining at least 30% reduction in weekly cluster attacks for at least 3 months were defined as responders. Treatment-related side effects were collected. Results: A total of 14 patients were included in this report (nine males). At a median follow-up of 6.5 (range 6-13) months post-procedure, eight patients (57.1%) were defined as responders to the treatment. Six patients were non-responders and reported either a reduction in frequency and severity of attacks for <3 months (2/6), no improvement (2/6) or temporary worsening of symptoms (1/6). The majority of patients (63.6%, n = 7/11) treated with >45 V were responders compared with responders treated with 45 V (33.3%, n = 1/ 3). Five patients (35.7%) experienced post-procedural side effects. Conclusion: This case series suggests that PRF targeting the SPG might offer a safe, minimally invasive and effective treatment for medically refractory CCH. Given the small number of cases and the short follow-up, larger and more robust studies will be needed to confirm our findings.

Long-term efficacy and patient satisfaction of pulsed radiofrequency therapy in temporomandibular disorders

“…A study with chronic refractory cluster headache reported a transient increase in pain intensity in 36% of treated patients. However, the method applied in this study was percutaneous, and other reported side effects were more closely related to the nature of the approach taken [32] . Another study on radicular pain also reported a temporary increase in pain intensity following treatment that lasted less than a day without any major side effects [33] .…”

“…However, the method applied in this study was percutaneous, and other reported side effects were more closely related to the nature of the approach taken. [32] Another study on radicular pain also reported a increase in pain intensity following treatment that lasted less than a day without any major side effects. [33] The participants of our study also did not report any major side effects due to treatment, and less than 2% reported discomfort with the intervention, with no statistically significant difference between the groups.…”

Efficacy and safety of ultrasound-guided pulsed radiofrequency therapy of stellate ganglion on refractory painful diabetic peripheral neuropathy

“…At the same time, the electrode tip temperature was maintained at 42℃without disrupting motor nerve function. Mild temperature energy of PRF therapy did not cause nerve damage and would not produce long-term clinical effects [24], Moor et al performs SG pulsed radiofrequency to treat cluster headaches (n = 2) and shows that 50%, 22%, and 28% have complete, marked/partial, and no improvement, respectively; through 12 months of follow-up, these reduced to 28%, 37%, and 37%, respectively [25]. In our study, we observed that the signi cant and total effective rates at 1-week post-procedure were 67.86% and 89.29%, and as time went on, the signi cant and total effective rates at 24 weeks post-procedure were 17.86% and 32.14%.…”

Safety and Efficacy of CT-Guided Pulsed Radiofrequency Combined with Steroid and Ozone Injection-Treated Cervical 3-8 Herpes Zoster Neuralgia Using a Posterior and Upper Quarter of the Cervical Foramina Puncture Approach

“… 8 Kim ED and Kim K have revealed that pulsed radiofrequency treatment of dorsal root ganglion in managing herpes zoster neuralgia has achieved ideal therapeutic effects, 9 , 10 and nerve block with steroid injection can also reduce all types of neuralgia. 11 , 12 It is worth mentioning that when herpes zoster is involved in the neck and upper limb, especially in the area of C3-C8, the adjacent vertebral artery and spine increase the puncture risk in this area. These injections are completed via an anterolateral approach.…”